RU2489979C1 - Method of double osteotomy of pelvis in treatment of children with hip joint pathology - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics and can be applied in surgical treatment of children with hip joint pathology. Osteotomy of pubic bone and then oblique osteotomy of iliac-bone in direction from inside outwards from top to bottom from anterior-inferior spine to greater sciatic notch are performed. Acetabular fragment is rotated at first outwards and anteriorly, and then cranially with overriding of pelvis fragments one behind other. Pelvis fragments are fixed in said position with Kirschner's wires.

EFFECT: method ensures exclusion of iliac bone shortening and muscular compression of hip joint, acceleration of terms of pelvis fragments consolidation, reduction of trauma due to absence of necessity to excise bone fragment from iliac bone, reduction of treatment terms.

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Description

The present invention relates to medicine, namely to orthopedics and can be used in the surgical treatment of children with pathology of the hip joint, for example, in the form of subluxation, dislocation of the hip, deformation of the head and cavity, etc.

Known methods for surgical treatment of pathology of the hip joint (Salter RB Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. J Bone Joint Surg [Br] 43-B: 518-39, 1961.), as well as (Pozdnikin Yu.I. Double pelvic osteotomy in the treatment of hip dysplasia // Orthopedist, traumatol. - 1980. - No. 9. - P.52-54), in which the ilium intersects from the anteroposterior spine to the large sciatic notch in a straight line, and the pubic the bone intersects re-acetabularly; the distal (acetabular) fragment rotates outward anteriorly downward, providing coverage of the femoral head. The resulting diastasis is filled with an allo or autograft (from the iliac wing). Fragments of the pelvis and transplant are fixed with needles.

Performing a pelvic osteotomy typically by the methods described above has some drawbacks: when the distal fragment of the pelvis rotates, it moves downward, which leads to compression of the hip joint, which is especially undesirable in the treatment of children with hip dislocation, as well as lengthening of the limb on the side of the intervention. The reduction of the reconstructed joint is accompanied by a pronounced muscle tension, which can cause degenerative changes in the articular cartilage and the development of the vicious position of the limb. Violation of the anatomical relationship between the left and right pelvic bones during reduction of the joint can also lead to biomechanical disorders that have a negative effect on gait and posture.

In addition, certain difficulties arise with the use of allo or autografts, fitting them in shape and size, installing and holding them in a given position, possible subsequent resorption of them and partial or complete loss of correction.

The objective of the invention is to increase the effectiveness of surgical treatment of children with pathology of the hip joint by applying the technique of surgery, which allows to provide cranial displacement of the acetabulum for decompression of the joint and to do without the use of a graft.

The technical result of the task is achieved by the fact that in the method of double pelvic osteotomy in the treatment of children with hip joint pathology consisting in an osteotomy of the ilium and pubic bone and rotation of the distal (acetabular) fragment outward anteriorly from top to bottom, it is proposed to perform oblique osteotomy of the ilium, from inside to top to bottom. to perform after rotation of the acetabular fragment a cranial displacement of the distal fragment of the pelvis with the passage of the fragments one after another, providing a dosed degree l correction to the full coverage of the femoral head and fix them in this position with Kirschner spokes.

Figure 1 - presents a diagram of the pelvic bone with the indicated levels of oblique osteotomy (left side of the pelvis, inside view) of the ilium and osteotomy of the pubic bone.

Figure 2 - presents a diagram of the left hip joint before surgery in a patient with subluxation of the thigh (front view).

Figure 3 - presents a diagram of the hip joint after displacement of the acetabular fragment and fixation in the position of correction with Kirschner spokes.

Figure 4 - presents the x-ray of the hip joints of the patient with subluxation of the thigh before surgery.

Figure 5 - presents the x-ray of the hip joints of the same patient immediately after surgery.

Pos. 1 - proximal fragment of the left pelvic bone.

Pos. 2 - distal (acetabular) fragment of the left pelvic bone.

Pos. 3 - lines of the ilium osteotomy (the dashed line indicates the direction and cross-sectional level of the external cortical layer of the ilium, the continuous line - the internal cortical layer).

Pos. 4 - line of osteotomy of the pubis.

Pos. 5 - the entry of fragments one after another after performing cranial displacement of the distal fragment.

Pos. 6 - Kirschner spokes.

The method is as follows:

Patient position on the operating table on a healthy side. An angular incision of the skin and subcutaneous tissue in the upper third of the thigh along the outer surface. After a cruciate dissection of the broad fascia of the thigh, an antero-inferior iliac spine is secreted in layers between the muscle straining the broad fascia and the middle gluteus maximus. The cartilaginous apophysis of the iliac crest is longitudinally dissected to the anteroposterior spine; then the incision is extended down to the anteroposterior spine. Subperiosteal expose the ilium from the anteroposterior spine to the large sciatic notch into which Gigli's saw is brought.

The upper branch of the pubic bone, which intersects with the chisel, is secreted in layers subperiosteally (Figs. 1, 2, 3 - item 4). Saw Gigli produce oblique (from the inside outward from top to bottom) osteotomy of the ilium from the large sciatic notch to the anteroposterior spine (Fig. 1, 2 - item 3). Acetabular fragment 2 is first rotated outwardly and anteriorly, until the femoral head is completely covered, and then it is casted cranially displaced with the fragments coming in one after another 5 to exclude the reduction of the hip joint. Fragments of the osteotomy are fixed in the position of correction with Kirchner spokes 6. The wound is sutured in layers, leaving Redon drainage. Apply an aseptic dressing. A control x-ray and lower limb immobilization are performed with a one and a half coxite plaster cast.

The positive effect of the proposed treatment method is as follows: during rotation and cranial displacement, there is no reduction in the acetabular fragment of the pelvis (and the entire hip joint) and, therefore, muscle compression of the reconstructed joint is excluded. The occurrence of fragments for each other also allows you to do without a transplant; this reduces the likelihood of loss of correction, accelerates the time of consolidation of fragments of the pelvis, which reduces the time of immobilization and treatment in general and increases its effectiveness.

Claims (1)

The method of double pelvic osteotomy in the treatment of children with hip joint pathology, including the pubic osteotomy and the ilium osteotomy from the anterior lower spine to the large sciatic notch, the rotation of the acetabular fragment outward, anteriorly, characterized in that oblique iliac osteotomy is performed from above to the top down, and after the rotation of the acetabular fragment, the distal pelvic fragment is cranially displaced with the fragments coming in one after another, they are fixed in this position with the needles of Cyrus schner.

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